The effect of acetate Ringer dextrose (5%) and lactate Ringer dextrose (5%) in surgical patients

The clinical evaluation of acetate ringer dextrose (AR-D) for hemodynamic status, metabolism of glucose, electrolytes in serum and urine, liver and renal function and acid-base balance were performed in surgical patients compared with lactate ringer solution (LR-D). The 20 patients scheduled for gynecological operations were randomized into 2 groups. After the administration of AR-D or LR-D, we examined their clinical effects. The results suggest that there were no significant differences between AR-D group and LR-D group. We cannot confirm that AR-D is a better solution for surgical patients than LR-D regarding metabolism of lactate, pyruvate and glucose during operations.     

Lactated Ringer as Preservation Solution in Living Donor Renal Transplantation

BackgroundOptimal organ preservation remains a critical hallmark event in renal transplantation as it is the supply line. Previous studies have shown that the choice of preservation solution may affect transplant outcomes. In this study, we aimed to present the early follow-up results of the graft and patients, using lactated Ringer to preserve kidney allografts with living donors.MethodsThe results of 97 living donor transplant operations performed in Sanko University Hospital were evaluated retrospectively. The patient's evaluation included demographics, dialysis time duration, renal replacement method, primary disease, comorbidity, surgical and clinical complications in the acute period, graft functions, blood levels of calcineurin inhibitor drugs, anastomotic renal artery, warm ischemia, and cold ischemia times.ResultsDonor (49 men, 50.5%) and recipient (58 men, 59.7%) demographics, HLA compatibility (mismatch), hospitalization days, and length of warm and cold ischemic time are summarized in Table 1. Primary nonfunction was not defined in any patients, but delayed graft function was observed during the follow-up of 3 patients (3.09%), who were all hypotensive in the post-transplantation period, and positive inotropic infusion was needed for hemodynamic stability.ConclusionsLactated Ringer demonstrated efficacy in terms of patient and graft survival, and its lower cost represents a financial advantage, so it can be used in living donor kidney transplantation because it is safe, effective, and inexpensive. Standard preservation solutions may still be recommended in cases with long cold ischemia times, such as paired exchange transplants and cadaveric transplants. Thus, randomized controlled studies are needed for further investigation.     

Volume kinetics of Ringer solution after surgery for hip fracture

PURPOSE: To study the time course of volume changes during and after infusion of Ringer's solution in elderly patients after a standardised trauma. METHODS: The kinetics of 12.5 ml.kg-1 Ringer's solution infused over 30 min were studied in ten patients one day after surgery for hip fracture (mean age, 70 yr) and in an age- and sex-matched control group. Hemodilution, as measured every five minutes for 90 min, was used to calculate the size of the fluid space expanded by the fluid (V) and the elimination rate constant (kr). The baseline fluid balance status in the patients and the controls was compared by bioelectrical impedance analysis. RESULTS: The size of V was 4.1 +/- 0.51 (mean +/- SEM) in the patients and 3.4 +/- 0.21 in the controls (P:NS) while the corresponding results for kr were 85 +/- 12 and 166 +/- 27 ml.min-1, respectively (P < 0.04). Bioelectrical impedance analysis showed that the extracellular fluid space and the total body water volumes did not differ between the two groups. Computer simulations based on the data obtained for V and kr indicate that trauma increases the dilution of the plasma volume and the retention of fluid in response to slow and moderate infusion rates, while these indices of short-term changes in fluid balance remain the same in the two groups during very rapid infusion of Ringer's solution. CONCLUSION: A slower elimination rate increased dilution of plasma and retention of fluid when Ringer's solution was infused in elderly trauma patients.     

全麻复合硬膜外麻醉患者林格氏溶液的容量动力学

目的 通过确定全麻复合硬膜外时麻醉林格氏溶液的容量动力学模型参数，评价硬膜外复合全麻对晶体液扩容效应的影响。方法择期行肝癌切除术患者20例，随机分为2组：组Ⅰ麻醉诱导前行扩容治疗，组Ⅱ硬膜外复合全麻诱导后行扩容治疗。扩容采用30ml／kg乳酸钠林格氏溶液（LR）恒速输注，30min内输完，输注LR开始后90min内每5min测定血红蛋白（Hb）及红细胞压积（Hct），并记录总尿量及血液动力学数据。用容量动力学数学模型和物质守恒定律处理数据，获得结果。结果 组Ⅱ容量增加量、容量扩张效率、输注结束时液体保留率均高于组Ⅰ（P〈0．05）。一级容量动力学分析结果：组Ⅰ目标容积（V）和清除率（k1）均大于组Ⅱ（P〈0．05）。二级容量动力学分析结果：组Ⅱ的V1、k1、k1均高于组Ⅱ（P〈0．05）。扩容后组Ⅱ的平均动脉压、中心静脉压、心输出量均小于组Ⅰ（P〈0．05）。结论 全麻复合硬膜外麻醉可提高晶体液的容量扩张效率。     

Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial)

Background  

In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications.     

Volume Kinetics of Ringer Solution, Dextran 70, and Hypertonic Saline in Male Volunteers

Background: A knowledge of the distribution of different fluids given by intravenous infusion is basic to the understanding of the effects of fluid therapy. Therefore, a mathematical model was tested to analyze the volume kinetics of three types of fluids.

Methods: The authors infused 25 ml/kg of Ringer acetate solution, 5 ml/kg of 6% dextran 70 in 0.9% NaCl, and 3 ml/kg of 7.5% NaCl over 30 min in 8 male volunteers aged from 25 to 36 years (mean, 31 years) and measured the changes in total hemoglobin, serum albumin, and total blood water over time. The changes were expressed as fractioned dilution and then plotted against time. The curves were fitted to a one-volume and a two-volume model, which allowed an estimation of the size of the body fluid space expanded by the fluid (V) and the elimination rate constant (kr) to be made.

Results: The changes in blood water concentration indicated a mean size of V of 5.9 l (+/- 0.8, SEM) for Ringer's solution, 2.6 (+/- 0.3) l for dextran, and 1.2 (+/- 0.1) l for hypertonic saline. The corresponding values of kr were 94 (+/- 42), 12 (+/- 6), and 30 (+/- 4) ml/min, respectively. Blood hemoglobin indicated a degree of dilution similar to that indicated by blood water. Serum albumin indicated a more pronounced dilution, which resulted in a larger expandable volume and a greater mean square error for the curvefitting. The larger volume obtained for serum albumin can probably be explained by a loss of intravascular albumin into the tissues along with the infused fluid.     

Lactated Ringer with 1% dextrose: an appropriate solution for peri-operative fluid therapy in children

Peri-operative blood glucose, total protein, and electrolytes values were measured in children (3–120 months) scheduled for minor surgery and randomly assigned to three groups according to the type of fluids administered during anaesthesia: children of RL group (n= 27) received lactated Ringer, those of RLD1 group (n= 25), 1% dextrose in lactated Ringer, and those in RLD2.5 group (n= 27), 2.5% dextrose in 0.4 N saline (50% D5, 50% RL) (63 mmol·l^-1). Infusion rate was set according to children's age and weight. Fluids were infused throughout the study with volumetric infusion pumps. Blood samples were obtained at induction (T0), at the end of surgery (T1), 30 and 60 min later (T2, T3). Pre-operative blood values were within the normal ranges except for high total protein values in all groups of children and for asymptomatic hypoglycaemia (2.3 and 2.5 mmol·l^-1) in two children. Blood glucose increased significantly in the three groups post-operatively (P < 0.001), and this increase was related to the amount of glucose infused. Glucose values differed significantly between groups at T1 and T2, while blood glucose values were back to the normal ranges at T2 and T3 in the RL group. Sodium values remained unchanged post-operatively in both RL and RLD1 groups, while a significant decrease was observed in the RLD2.5 group (P < 0.001). Total protein decreased in the three groups post-operatively (P < 0.001) towards normal values. These data suggest that RLD1 is appropriate for peri-operative fluid therapy in children. Its administration at the infusion rate used in this study, resulted in moderate post-operative hyperglycaemia while avoiding the risk of peri-operative hypoglycaemia, maintaining a constant extracellular fluid composition and correcting pre-operative fluid deficit.     

Experimental study on interdigestive migrating contractions with intestinal transection and injection of Ringer solution into intestine

The occurrence and mechanism of IMC are still not completely elucidated. Base on the conjecture of that the region of intestine and its ingredients may be concerning with the conduction mechanism of IMC, following experiment was performed by author. Small intestine was cut into two parts. Anal side was closed as blind end, and the end of oral side was sutured to colon or anal part of intestine by end to side anastomosis. Gastric fistula and intestinal fistula of the blind ending intestine were also made, and six pieces of force transducers were sutured to the serosa of the intestine in order to observe the movement of intestine. Under non-anesthesia and non-restricted condition for whole day long, Ringer solution was injected into gastric or intestinal fistula by 50 ml one shot or continuous dripped infusion of 250 ml per hour. The result is: In upper part of intestine, the appearance of IMC in oral and anal side of intestine is continuously observed. However, in lower part of intestine, the IMC of oral and anal part of intestine appeared completely independent without any continuity. And, as one shot of 50 ml of Ringer solution was injected, the conduction of IMC was suppressed but still observable, while continuously infused of 250 ml/hr, the IMC was completely disappeared.     

Effect of intraoperative acetated Ringer’s solution with 1% glucose on glucose and protein metabolism

Purpose  

To investigate the effects of the intraoperative administration of Ringer’s solution with 1% glucose on the metabolism of glucose, lipid and muscle protein during surgery.     

Changes in the plasma protease systems during open-heart surgery with dextran vs. Ringer acetate as priming solution

Two different priming solutions for cardiopulmonary bypass (CPB) were studied in regard to possible influence on the plasma protease systems. The study was performed on 20 patients undergoing elective coronary artery bypass grafting. In ten cases the priming solution contained 1,000 ml dextran (MW 70,000) and in ten it consisted only of Ringer's acetate solution. The same level of haemodilution was established during CPB in the two groups. Clinical variables and laboratory data were monitored. Spontaneous kallikrein activity, plasma prekallikrein, functional kallikrein inhibition capacity, spontaneous plasmin activity, plasminogen, functional antiplasmin activity, prothrombin and antithrombin-III were measured, using chromogenic peptide substrate assays before and during CPB as well as in the postoperative period. The antiplasmin activity decreased more in the dextran than in the Ringer group following cardiopulmonary bypass but the difference was without clinical significance. No statistically significant intergroup difference was found in the other measured variables of the kallikrein-kinin, fibrinolytic and coagulation systems.     

Clinical examination of acetated Ringer solution in patients with normal liver function and those with liver dysfunction]

Acetated Ringer solution (AR) was studied clinically to find its usefulness in patients with liver dysfunction compared with lactated Ringer solution (LR). The thirty-eight patients scheduled to be operated were divided into four groups (Group I: with normal liver function and AR infused, Group II: with normal liver function and LR infused, Group III: with liver dysfunction and AR infused, Group IV: with liver dysfunction and LR infused). AR or LR was administered to each group at a speed of 10 ml.kg-1.h-1, and we investigated the differences of these four groups clinically. L-lactic acid increased significantly in all groups after administration of AR or LR. D-lactic acid increased in LR groups, and acetic acid increased in AR groups. However, the other parameters, including the acid-base balance, electrolytes and liver function, showed no significant changes in any group. Therefore the status of liver dysfunction did not affect the metabolism of lactic acid in this study. These findings indicate that as an intraoperative fluid, AR is just as useful as LR. However, there was no significant difference between the data of AR groups compared with those of LR groups. In conclusion, AR is not necessarily a better fluid compared with LR as an intraoperative fluid in patients with liver dysfunction.     

Effect of Ringer infusion on ischemic acute renal failure: caution on interpreting the results of short-term studies

The effect of a 4.5 mL/h Ringer infusion on the recovery from a unilateral 40-min renal artery occlusion was investigated in Sprague-Dawley rats. The inulin clearance measured in the experimental kidney 24 and 48 h after the insult in control animals that did not receive the Ringer infusion was 0.14 +/- 0.10 (mean +/- SE) and 0.11 +/- 0.05 mL/min, respectively. In animals that received 24 h of Ringer infusion begun at the time of the renal artery occlusion the inulin clearance was 0.81 +/- 0.07 mL/min, a value significantly higher than either of the control groups (p less than .05). If, however, the Ringer infusion was stopped at 24 h and the inulin clearance measured at 48 h, it had decreased significantly (0.27 +/- 0.09 mL/min) and was no longer greater than the control groups. Similarly, if the infusion was continued for 48 h there was no longer a significant difference between the inulin clearance (0.37 +/- 0.11), when compared with 48 h of no infusion (0.11 +/- 0.05). The histology of the different groups corresponded with the functional data. We conclude that 24 h of Ringer infusion leads to functional and histological protection when measured at 24 h; however, if measured at 48 h, protection is no longer evident. These studies suggest that caution should be exercised in extrapolating from the results of protective maneuvers in ischemic acute renal failure investigated by short-term studies.